Medicine, Health Care and Philosophy

, Volume 18, Issue 1, pp 13–22 | Cite as

Health-care needs and shared decision-making in priority-setting

  • Erik GustavssonEmail author
  • Lars Sandman
Scientific Contribution


In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.


Needs Health-care needs Shared decision-making Desires Priority setting Rationing 



We would like to thank Niklas Juth, Lennart Nordenfelt, Ingemar Nordin and Gustav Tinghög for helpful discussions and comments on earlier drafts of this paper.


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Division of Health and Society, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  2. 2.The National Center for Priority Setting in Health Care, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  3. 3.School of Health SciencesUniversity of BoråsBoråsSweden

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